There’s a joke about a woman whose blood pressure was 180/90.  She didn’t think she had reason to be concerned.  After all, she argued, 180/90 is the mathematical equivalent of 2/1 and that doesn’t seem so high, does it?

I once treated a young man of color, obese and sad looking, whose numbers were close to this – 170/100.  And I was not laughing.

This young man was schizophrenic for sure, but pretty harmless.  Life had beaten him down enough that his jail experiences — assault, as directed by disembodied “voices” — had him so frightened that he would never do anything the voices said. Not now, not ever, and I believed him.

As a psychiatric physician, I always managed to get “vital signs” on all patients.  That should not have been a battle, but it was. I did not understand nor relate to the medical assistants who took them.  Why?  18 months training after high school and they had not been nice to me — not at all — criticizing my lunch and the fact they did not think I worked hard enough.

I was concerned when I saw a blood pressure of 170/100.  Patient said he had been on some kind of medicine.  The best I could get with one of my “naming medicines and seeing what it sounded like” was hydrochlorothiazide — maybe. And of course the relevant parts of the chart were missing, as was the case more than actually finding anything.

He said he had stopped his medications a couple of days before because they gave

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